title: Follow-up of Helicobacter pylori infection in children over two decades (1988-2007): persistence, relapse and acquisition rates.
abstract: Helicobacter pylori culture on gastric biopsy was performed on 4964 subjects aged <18 years from 1988 to 2007 at a central laboratory in Brussels. The total number of biopsies increased markedly from 941 in 1988-1993 to 1608 in 2004-2007. Biopsies were repeated at least once for 922 subjects (603 initially negative and 319 initially positive for H. pylori). Persistence rate of H. pylori at 1 year after initial positive biopsy was greater in the 1998-2007 cohort than in the 1988-1997 cohort (72.7% vs. 45.8%, P = 0.002), suggesting a tailored selection of candidates for biopsy with non-invasive tests (13C urea breath test). Of 68 subjects initially positive and re-examined subsequently after a documented cure, re-infection/relapse rate was 48.6% within 5 years post-elimination of H. pylori. Acquisition rate over 10 years follow-up in the initially negative cohort (603 patients) was 38.7% (re-infection/relapse vs. acquisition: P < 0.001). Multivariate analysis showed a fourfold greater risk of H. pylori acquisition in children of non-European origin vs. European origin (P < 0.001). Clarithromycin and metronidazole susceptibility were determined in 226 and 223 paired positive cultures in cases of re-infection/relapse or persistence. An initial non-susceptibility profile was highly predictive of a subsequent non-susceptibility profile, and the non-susceptible proportion increased markedly from 13.3% to 21.2% for clarithromycin (P < 0.001) and from 27.3% to 35.0% for metronidazole (P = 0.014), with no difference regarding European or non-European origin.
authors.affiliation: Medical Microbiology Laboratory, Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Vanderpas
authors.affiliation: Paediatric Gastroenterology-Hepatology Department, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Bontems
authors.affiliation: Clinical Biology Department, Section of Microbiology, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: V Y
authors.initials: VY
authors.lastname: Miendje Deyi
authors.affiliation: Paediatric Gastroenterology-Hepatology Department, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Cadranel
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001530:Belgium / Q000453:epidemiology; D001706:Biopsy; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000494:pharmacology / Q000627:therapeutic use; D015999:Multivariate Analysis; D012008:Recurrence; D013270:Stomach / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D017291:Clarithromycin